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HomeMy WebLinkAboutFood Service Establishment Inspection 64 - I� SIATE]OI�,COI+1fLt+C1"ICIII1 D$ ItItl�I�S © PORT -� DEPARPNIiTIFrBIE LTI c " ..���� ,.Q .._ -•- six.-: Establishment: (h+,e S 1� ' Inspection Date: (� Time: G_. . (ROinsp RE[ns Address/City: ke s,'5- \\k u t,kc\ -C , Health Dept: S- bi�.j : n u/ : 1 2 4 • Based on an inspection this day,the items marked D N C identify the ' lotions in operation or facilities which must be corrected by the date specified on page 2. RISK FACTOR ITEMS:Listing is not inclusive of all possible debitable items C tO N!A DNC �; C(complies] N10[not observed] N!A[not applicable] 60 Qtldlifled'Food Operator g DNC[does not comply] 0[other] RTE[ready-to-eat] 61 Designated Alternate' 2 121 Personnel,with infection restricted N10 N/A 4 A Food workers have no exposed infected lesions 1 burns 62 Written documentation of training program 2 B Personnel with infection restricted 1 Approved source,wholesome,nonadulterated C V10 NIA 4 C Communicable disease of worker reported to local health director A I Approved shellfish,finfish,meat&poultrUSDA approved 13 Handwashingfacilities provided,hands washed,clean N10 NIA 14 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all fend prepldispensing&warewash areas C Wholesomelnonadulteratedfoods/safe B Handwash facilities in or immediately adjacent to toilet rooms D Commercial products{no home grown/canned food} C Handwash facilities accessiblelconvenient to use E Potentially hazardousfoods received at proper temperature D Personnel hands washed,clean I Proper handwash procedure 0 E Handwashing at appropriate times 3 Potentially hazardous food meats temperature requlrements, C N10 N/A 4 0 during storage,preparation,display,service and transportation ' 15 Good hygienic practices N10 NIA `2 A Hot holding greater than or equal to 140°F. (wholebeerlpork roosts U00 F.) ✓ A ❑ No eating ❑No smoking while working B Cold holding less than or equal 10 45"F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking/consumer advisory posted 24-Sanitization rinse(hot.water-chemical) C WO NIA 2 A Approvedsanitizer available/adequate concentration ofsanitizer t4 , Adequate facilities to maintain.product C N10 NIA B Food-contact surfaces and utensils used for potentially temperature,thermometers provided' hazardous food sanitized at least every 4 h s A Food thermometer available and accurate C Adequate ❑dishwashersanitizer gfinalrinsetemp B Proper food thermometer for product L Proper sanitizin rocedure E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 0 25 'Clean wiping"cloths 0 N/A 1 7 Food protected during storage,preparation, C N10 N/A 2' - display service'and transportation A Cloths and/or sponges in good repair and clean A Produce washed B Wiping cloths kept in sanitizer between uses 0 B Raw meats not stored/prepared near ready-to-eat foods 26 `Food-contact surfaces clean IO WA 2 4 C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards 1 sneeze guard B Single use gloves changed when soiled Ile E No unauthorized personnel C Food--contact surfaces clean F No pooling of eggs not cooked immediately ool 0 S Food containers stored off the floor -30 Hot-and cold water under pressure;provided as required C N10 N/A'_2_ 0 36 1,Han6vashing accessories provided C,N/0 NIA 9 Handling of food minimized , C .N10 NIA 2 A No unnecessary handling RTE and/or cooked foods with bare hands A Soap/paper towels 1 drying device available B Dispenser(s)working: ❑Soap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)clean/waste receptacle at handwash sink 01 C Adequate utensil(s)fordispensing food/ice I j p 1 t 0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. KEY: QFO[qualified food operator],DA[designated alternate],PHF[potentially hazardous food],FB[foodborne] PHFs are hot held at: °F. PHFs are cold held at: OF Describe illness conditions when you would exclude a food worker from working: Are internal cooking temperatures taken? Y N *To what temperature do you cook: Poultry Ground Beef Pork What diseases related to FS illness are you required to report to the local health department? Roasts Other Describe re-heating procedures: Is there a written illness policy that requires the food worker to report specific illness conditions Are temperatures recordedllogged for cold holding foods/equipment? Y N and diseases to the QFO? Y N ♦Do you have a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N *Are leftovers saved? Y N Is there a language barrier between Inspector&QFO? Y N iLyas indicate language spoken List products cooled: by QFOIDA: *Can the QFOIDA read the inspection report? Y N Describe cooling methods: Indicate who answered the above questions: Name(print): Indicate the title of above person(circle all that apply]:QFO DA Mgr Cook Owner FW Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N .Obtain signature of the person who received the QFO responsibilities information at the time of the Is there a produce washing policy? Y N *Describe what is washed and inspection: where: Note: This report is a two page form(total of 62 dabitable items) Page 1 of 2 Eetbt #ritr�t '° f Inspection Adi ea W � �\ 4 r }I - Owner-,or Operator: a M1 ADDITIONAL FOUR POINT ITEMS 0& KEY: DNC [DOES NOT COMPLY] e 6 Foods not re-served. -Unwrapped foods not re-served 4 31 Sewage disposal approved. 4 -Potentially hazardous foods not re-served -Operating as required 11 Toxic chemicals. 34 No cross connections,back siphonage,backflow 4 4': Propertypelinsta lalionl backflow prevention device/air pan for: -Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines -Sanitizer concentration not toexceed maximum permitted -Soda system carbonator -Beverage dispensers -Toiletfanks -Na unnecessary toxics on the premises -Chemical dispensers -Ice machines -Pesticides/rodenticides properly dispensed Proper drain for: 29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines -Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, 4 -Water quality in compliance-Monitoring in compliance designed,properly installed OTHER ITEMS z.: KEY: DNC [DOES NOT COMPLY] rn�_ Sources of food: Original container,properly labeled 40 Garbage/rubbish storage area/rooms,enclosures-properly constructed,dean 1 5 Potentially hazardous food properly thawed 2" 41 Garbagelrubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored 1 42 Vermin Control:No insects/rodents present 2 I 4i Food worker:Clean outer clothes,effective hair restraints 43 Outeropenings protected againstentranceof insectslrodents 1 4 Floors:Floor covering installed,constructed as required,good repair,clean 1 16 Food-contact surfaces designed,constructed, maintained,installed, 2 5 Floors graded,drained as required located 46 Floor,wall juncture covered 17 Nonfood-contact surfaces designed,constructed,maintained, 1 47 Mats removable,good repair,clean installed,located 1 48 Exterior walking,driving surfaces,good repair,clean 18 Single service articles,storage,dispensing `2 19 No reuse of single service article 49 Walls,ceilings attached,equipment properly constructed,good 1 repair,clean.Wall&ceiling surfaces as required 20 Dishwashing facilities approved design,adequately constructed, 2 1 maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored EEquipment&Utensils: Cleanliness 51 Adequate lighting provided as required 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors J 22 Wash water clean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required 23 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean 1 27 Nonfood-contact surfaces of utensils&equipment clean 1 55 Establishment and premises free of litter,noinsectlrodentharborage, 1' 28 Equipmentlutensils,storage,handling 1 no unnecessary articles } 32 Proper disposal of wastewater 1, 56 Complete separation from livinglsleeping quarters and laundry 1 33 Plumbing location,installation,maintenance L` 57 Cleanlsoiled linens stored properly 58 No live birds,turtles,or other animals(except guide dogs) 36 Toilet rooms enclosed with self-closing door 59 Seats "or more:Nonsmoking area provided,sign(s)posted at 3 37 Proper toilet fixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, 1 rodent proof,clean 2koutine Inspection 1711einspection E3 Preoperational Inspection Other Inspection: INSPECTOR: J� PERS0N IN CHARGE: I Demerit Score: *Include demerits from page 1 CJ 4 3 2 1 Total Rating sig ture � sig ire ,5� S7 print name 06) �t u L ` C� 6`b1� ONS DUE: phone number title X,Z Page 2 of 2 plus continuation pages Focused Inspection 1/2002 Page of J INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION %orn\ e s Q,b c� 1� aS LAi: INSPECTION REMARKS FORM# Lk fl)A-�Q �JALJtA)C4 JO PdkK- 2 2 Q &V) C)�a /J,//� a )/-AiL, Tizeru/ fu MNA INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) s Distribution: Ist-White-Health Department 2nd-Yellow-Owner/Manager